Headaches, Enuresis (Bed Wetting), Nocturia (Frequent Urination)
and Abnormal Heart Rhythms During Sleep



Understanding the symptoms of sleep disorders.

Click on the topic of interest:
Analyzing the problem.
-Sleepwalking, screaming, arousals with panic & frantic, agitated behaviors.
-Abnormal body movements during sleep.
-Eating during sleep.
-Inappropriate sexual activity during sleep ("sleep sex") .
-Biting of the tongue or inside of the cheek during sleep.
-Bruxism (toothgrinding; toothclenching).
-Night sweats (sleep-related hyperhidrosis).
-Headaches related to sleep.
-Enuresis (bed wetting) and frequent urination at night (nocturia).
-Abnormal heart rhythms during sleep.
-Choking, shortness of breath and chest pains occurring during sleep.
-Sleep paralysis.



Many causes are possible-- some serious, but others not.  Most sleep-related headaches are not due to brain tumors or other serious brain abnormalities.  Causes include:

-Sleep apnea -- an extremely common cause of headaches on awakening.  May involve dull, pressure like pain or a pounding headache.  May result in part from repeated swings in cerebrospinal fluid pressure: induced by struggling to overcome upper airway collapse (which can cause a headache similar to that experienced following a ‘spinal tap’).  Look for sleep apnea symptoms as listed above in the section on night sweats.  Also, note if they are more intense when you find that you were sleeping on your back, and also, if they are milder or less frequent when you sleep in a reclining chair.

-Migraine -- also a common cause of headaches on awakening, especially after ‘sleeping in late’ (for example, on weekends).  These are usually “sick headaches” with nausea (and in some cases, with vomiting, sweating, sensitivity to bright lights, and even diarrhea).

Migraines may begin on one side of the head with subsequent spread to both sides.  The pain tends to be pounding or throbbing, and it usually will be partly relieved by pressing over the scalp, or by applying cold compresses -- at least when the headache is just beginning. 

Visual symptoms (sparkling lights, shimmering, bright spots or patterns, or blurring) or other neurological symptoms can occur.Usual reaction to pain: person wants to lie in a darkened room. Precipitating factors include stress, relief from stress, many specific foods, alcohol, menstrual periods, travel, changes in weather.

-Sinus congestion -- usually occurs over the sinuses, with a pressure sensation and sometimes with other symptoms of nasal congestion. Relieved by achieving sinus drainage (for example, with hot showers, warm compresses, saline sprays or decongestants).

-Neck pain related to arthritis and other orthopedic problems may be aggravated by sleep-- sometimes related to specific pillows and body position.

-Cluster headaches are intense, excruciating headaches, involving one side of the face with watering and often redness of the eye, drooping of the eyelid and nasal congestion on the same side as the pain.

Typically last 30-90 minutes and occur 1-6 times per day, in clusters lasting weeks to months.

Frequently occur in sleep and specifically, in conjunction with REM sleep.

Typical reaction to pain: frantic pacing, agitation, hitting the wall, etc.

Most common in men over age 20 with a smoking history.

            -Alcohol ingestion and sleep apnea can precipitate cluster attacks, and inhalation of oxygen may relieve them.

-Chronic paroxysmal hemicrania is a disorder that somewhat resembles cluster headache in the following respects: similar location and symptoms (eye watering, nasal congestion, etc.) and occurrence from REM sleep.  However, it differs in the following:

            Attacks are less prolonged (5-30 minutes) and more frequent (ten to thirty attacks per day!).

            Occur primarily in women, sometimes at younger ages, and in some patients can be precipitated by head turning.

-Many other medical, neurological and sleep disorders can cause sleep-related headaches.  If your headaches don’t seem to fall within any of the types just described, ask yourself the following questions and discuss them with your doctor:

--Do they wake me up -- or do I notice them when I awaken?
--When do they occur?  Middle of the night or on final awakening?  From REM or non-REM sleep?  Weekends or weekdays?
--Where are they located?  One or both sides of head, forehead, eyes, face, jaws/ TM joints, top/ back of head or neck?
--How do they feel?  Pounding, throbbing?  Dull steady pressure, or squeezing like a vise?  Sharp, jabbing pain?
--What other symptoms occur at the same time as my headaches?  Nausea, visual symptoms, etc.
--What makes them worse?  Sleeping in late, sleeping on my back, sleeping without or with pillows, stress or relief from stress, nasal congestion, alcohol, certain foods?
-What makes them better?  Pressing over my scalp, caffeine, prescribed or over-the-counter medications, eating, relieving sinus congestion, etc.


-Primary enuresis.

Refers to persistent bedwetting beyond age 5: without long “dry periods” followed by relapses. Often “runs in families”, perhaps due to an inherited tendency for delayed maturation of bladder control.  Sometimes, it appears that affected relatives outgrow the problem at roughly the same age!

Sometimes associated with a tendency to sleep very soundly and to have other abnormal sleep-related behaviors and events.

May respond to fluid restriction, exercises to increase bladder capacity and rewards for dry nights.  While special nasal sprays (which contain a hormone that reduces urine output) and oral medications may help, it is safest if the problem can be managed without any risk of drug side effects.     

-Secondary enuresis.

Refers to development of bedwetting in older children and adults who had been free of this problem.

Much more likely than primary enuresis to be caused by an underlying medical problem: including (but not limited to) sleep apnea, diabetes, urinary infections, kidney/bladder problems, and seizures.

A complete urinalysis and urine culture should always be considered, as well as checking for indications of sleep apnea  (which, in addition to snoring, morning headaches, sleepiness and other symptoms as listed above under Night Sweats, can cause distractible, hyperactive behavior in children).  Excessive thirst and increased daytime urination should prompt suspicions of diabetes.  Referral to a urologist is particularly appropriate when waking loss of urine, abnormalities of the urinary stream and repeated urinary infections have been experienced.

-Nocturia (frequent awakenings to urinate).

Although urologic problems (ex: prostate enlargement in men and bladder dysfunction in women) can be responsible, sleep apnea is an extremely common cause of this symptom. One study found that nearly half of patients seeing urologists for nocturia had sleep apnea as the underlying cause.

Why? Swings in the pressure within the chest induce increased release of a hormone from the heart called atrial natiuretic peptide, which causes increased sodium in the urine--which in turn pulls more water from the bloodstream into the urine, and urine volumes hence are increased. It is not surprising, then, that many patients with sleep apnea are amazed by the fact that once their sleep apnea is treated, they no longer awaken repeatedly to urinate.


The brain modulates our heart rhythm in ways that change dramatically during sleep.  For example, some people experience excessive slowing of their heart, even to the point their heart stops beating completely (asystoles) for periods of 8-10 seconds or longer, in REM sleep, during bursts of rapid eye movements and as a consequence of abrupt brain activity that influences heart rate.  Such can happen even if they have no heart disease per se.  Also, some abnormal sleep events (particularly sleep apnea) also can alter heart rhythm.  For example, some patients show excessive slowing of their heart -- even to the point of asystoles (complete lack of any heartbeat) while they are struggling to overcome upper airway collapse -- after which their heart may race, and at which point flurries of abnormal beats or “extra beats” (extrasystoles) may occur.

Some patients arouse when having abnormal rhythms and may experience palpitations, light-headedness, shortness of breath or chest discomfort.  However, many never awaken at these times, and their problem may only be detected during 24-hr. ambulatory (“Holter”) heart monitoring or during hospitalizations.

Finally, it is important to know that one particular and very common heart rhythm abnormality (atrial fibrillation) is strongly associated with sleep apnea and can make it more severe.

Sleep evaluations can help determine whether treatment of underlying sleep problems will take care of these sometimes serious rhythm abnormalities, or if instead, specific heart medications or pacemakers will be necessary

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Columbus, Ohio, Central Ohio, hospitalssleep, wake, insomnia, sleepiness 

Accredited by the American Academy of Sleep Medicine.

Robert W. Clark, M.D., Medical Director
1430 South High Street, Columbus OH 43207

Tel: [614] 443-7800
Fax: [614] 443-6960

e-mail: flamenco@netexp.net 

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